{"id":1325,"date":"2017-03-29T12:37:18","date_gmt":"2017-03-29T10:37:18","guid":{"rendered":"https:\/\/www.namfisa.com.na\/educates\/?p=1325"},"modified":"2025-07-17T10:14:47","modified_gmt":"2025-07-17T08:14:47","slug":"important-considerations-when-choosing","status":"publish","type":"post","link":"https:\/\/www.namfisa.com.na\/educates\/important-considerations-when-choosing\/","title":{"rendered":"Important Considerations When Choosing a Medical Aid Fund"},"content":{"rendered":"\t\t
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Choosing the Right Medical Aid Cover in Namibia<\/h3><\/span><\/div>
medical aid fund benefit option is not a one-size-fitsall.\nYou must consider the cover you need, how much\nmoney you can spend on contributions and whether\na specific benefit option has any features that don\u2019t suit\nyou. Choosing the right medical aid cover for you and your\nfamily is very important. There are many options to choose\nfrom and before you make a decision, you may need to ask\nyourself a few questions\n

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  • <\/span> What Can You Afford? (Premiums can range from N$1,000 to over N$10,000 The more cover you want, the higher the cost)<\/li>
  • <\/span>What Cover Do You Need? (Medical aid typically includes: In-hospital expenses, out-of-hospital expenses)<\/li>
  • <\/span>Can You Cover Out-of-Hospital Costs Yourself? (you may only need hospital cover If not, look for a plan with a Medical Savings Account )<\/li>
  • <\/span>Age and Health Status Matter Younger and healthier? (You may need basic cover Older or managing chronic conditions)<\/li>
  • <\/span>Understand the Fund\u2019s Stability Check the reserve level (Choose a fund with a solid financial base)<\/li>
  • <\/span>Administration & Claims (Choose a fund with a reliable administrator for smooth claims and support )<\/li>
  • <\/span>In-Hospital Benefits & Exclusions (Check what percentage of NAMAF tariff your plan covers, be aware of co-payments and exclusions)<\/li>
  • <\/span>Out-of-Hospital Benefits (New generation plans give you annual savings up front, these cover daily medical expenses until used up)<\/li>
  • <\/span>Chronic Medication (Confirm your condition and medication are on the fund\u2019s approved list)<\/li>
  • <\/span>Special Programs - Oncology, Dialysis, HIV (Ensure you understand what\u2019s covered and how to access benefits)<\/li><\/ul><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    Point by Point: What You Need to Know<\/h3><\/span><\/div>
    How much can you afford to spend?\nWhen deciding to join a medical aid fund, first ask yourself\nwhat you can afford to spend on the monthly premiums. If you\nneed to see a dentist, you\u2019ll want a policy that pays for it. If you\nneed an operation you\u2019ll want to be booked into a private ward\nin the best hospital in Namibia. But are you willing to spend\nN$10,000 per month for such a benefit privilege? If your budget\nis between N$1,000 and N$1,500 a month, it is always best to\nchoose a benefits option that is affordable. Knowing how much\nyou can spend reduces most of the work.\n

    \nWhat medical cover do you need?\nMedical aid cover is broken down into two parts:\nIn-hospital expenses (which happen while admitted into a\nhospital) and\nOut-of-hospital-expenses (doctors, dentists and over the\ncounter medication).\nWithout knowing what you need from medical aid cover,\nyou will not know which medical aid benefit option to choose. Therefore you will need to ask yourself the following questions:\nHow much did you spend on day-to-day medical expenses\nduring the past year?\nHow much did you spend on visits to the doctor \u2013 N$3,000?\nHospitalisation \u2013 N$0? Dentistry \u2013 N$5,000? Medicine \u2013\nN$2,000? If you already belong to a medical aid fund, it\u2019s even\neasier. Just ask them to send you a copy of your claims history\nfor the last twelve months;\nWhich of those expenses where once off and which won\u2019t\ncome up again soon (like maternity)? Which are likely to come\nup again and again (Like the flu)? Twice a year you should see\nthe oral hygienist, so this needs to be included in the budget.\nCan you pay on your own out-of-hospital expenses?\nIf yes, then look at medical aid fund options that just covers\nyour hospital requirements;\nIf you don\u2019t have enough money, then consider a medical\naid benefit option with a savings account (MSA) attached to it.\nMore information can be found by reading the out-of-hospital\ncover section of this article.\nIf you find that you do not use the medical aid as much and\nis unlikely to claim unless you need a serious operation, then\nall you need is a simple hospital benefit option. If you run out\nof savings by March, then you need a plan with much higher\nsavings\n

    \na 20 year old who hasn\u2019t seen a doctor\nsince the day his mother gave birth to him needs something\nquite different from the 50 year old with high blood pressure\nand diabetes.\nThe younger you are, generally, the healthier you are. That\nmeans you may need less coverage. The older and sicker you\nare, the more medical aid cover you need.\nMembership and reserve level\n

    \nAccumulated funds (reserves) is the net asset value of medical\naid funds, and must be maintained at the minimum prudential\nrequired reserve level (\u201creserves level\u201d), i.e. 25% of gross\ncontributions. It is very important to look at the medical aid\nfund\u2019s membership status and reserve level. Some funds have a\nbig membership base, but their reserve level is far below or close\nto the prudential minimum required level of 25%. This means\nthe fund is likely to have a bigger premium increase at the end of\nthe year. Reserve levels may drop annually, should a fund have a\nbad claims experience that year.\nOther funds\u2019 membership might be small, but the reserve level\nis high, which means enough funds are available and premium\nincreases at the end of the year can be expected to be lower than\nthe average in the market.<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    Administration<\/h4><\/span><\/div>
    It is important to know who the Fund Administrator is and how efficient they are in offering assistance, client services and\npaying out claims.\nIn-hospital benefits, exclusions and co-payments\nBefore deciding on which medical aid fund benefit option\nyou want to join, you have to look at the cover each one offers\nyou. The most important question is, how are you covered in\nhospital?\nMost medical aid funds benefit options cover you at 100%\nor more of the Namibian Association of Medical Aid Funds\n(NAMAF) tariffs. Other options cover you at 120%, 150%,\n200% or even 225%. This means it is always vital to negotiate\nrates with the medical provider (anaesthetist, specialist, doctor,\netc.) If you don\u2019t do that, you will be liable for the difference in\ncosts\n

    \nThe other option is to take out an additional product to\ncover that cost, like additional insurance cover.\nALWAYS read the small print. Study your product brochure\nto make sure of what is excluded on your option. Some medical\naid funds will exclude joint replacements or neck and back\noperations, so it is VERY important to take note of exclusions.\nYou will then know exactly what you are covered for and what\nis not included in your package, so that you are not caught off\nguard.\n

    \nIt is also important to be aware of all co-payments. Many\nmedical aid funds have co-payments (i.e. covered from your\npocket) on certain procedures, like gastroscopies, laparoscopies,\nremoval of wisdom teeth, colonoscopies and joint replacements.\nCo-payments differ from fund to fund and also depend on\nwhether the procedure is done in or out of hospital.<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    Out-of-hospital cover<\/h4><\/span><\/div>
    Some medical aid fund benefit options in the marketplace\nwork with \u201csavings\u201d. These are called New Generation options,\nwhere you are given a percentage of your monthly premium\nupfront for the year. This is available to you immediately,\ndepending on the applicable waiting period.\nThese \u201csavings\u201d will be used for almost everything outside\nof hospitalisation and also for any co-payment you might have.\nOnce the savings have been depleted for the year, you will have\nto pay for the out-of-hospital expenses out of your own pocket.\n<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    Chronic medication<\/h4><\/span><\/div>
    When it comes to chronic medication, first make sure it\nis covered on the option you want to join. Ensure that your\ncondition is regarded as chronic and that the medication you\nuse is also covered. Most people join an option because it covers\ntheir condition, but when it comes to the medication, the medical\naid fund says it is not on their formulary and is not covered. They\nwill then request you to use an alternative. If that is not possible,\nthey will pay you the Namibian dollar amount for the alternative\nand you will be liable for the difference in cost.\nOncology, dialysis and HIV\nYou also have to make sure how the medical aid fund and\noption cover oncology, dialysis and HIV. Most medical aid funds\nhave specific benefit programmes for these conditions, which\noffer good cover, but it is important to make sure exactly what\nthat cover is.<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    Conclusion<\/h3><\/span><\/div>
    In conclusion, once you have familiarised yourself with the\navailable options offered by your respective medical aid fund, it\nwill be easier for you to select a cover that is right for your needs.\nBy answering the questions in this article you now know:\n\n\n

    \n\n1. What can I realistically afford per month?
    \n\n2. Do I need in-hospital only or comprehensive cover?
    \n\n3. What are my regular medical needs based on past expenses?\n\n

    \nNow you can start shopping and comparing various medical\naid fund benefit options and remember to choose the option that\nbest meets your medical needs.<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    References<\/h5><\/span><\/div>
    http:\/\/www.insurancefundi.co.za;
    \nhttp:\/\/www.fin24.com\/Money\/Health\/How-to-choose-theright-\nmedical-aid-20141017;
    and
    \nhttp:\/\/www.medicalaid.co.za\/medicalaid\/importantconsiderationswhenchoosingamedicals.\naspx<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

    Choosing the Right Medical Aid Cover in Namibia medical aid fund benefit option is not a one-size-fitsall. You must consider the cover you need, how much money you can spend<\/p>\n","protected":false},"author":1,"featured_media":1327,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_EventAllDay":false,"_EventTimezone":"","_EventStartDate":"","_EventEndDate":"","_EventStartDateUTC":"","_EventEndDateUTC":"","_EventShowMap":false,"_EventShowMapLink":false,"_EventURL":"","_EventCost":"","_EventCostDescription":"","_EventCurrencySymbol":"","_EventCurrencyCode":"","_EventCurrencyPosition":"","_EventDateTimeSeparator":"","_EventTimeRangeSeparator":"","_EventOrganizerID":[],"_EventVenueID":[],"_OrganizerEmail":"","_OrganizerPhone":"","_OrganizerWebsite":"","_VenueAddress":"","_VenueCity":"","_VenueCountry":"","_VenueProvince":"","_VenueState":"","_VenueZip":"","_VenuePhone":"","_VenueURL":"","_VenueStateProvince":"","_VenueLat":"","_VenueLng":"","_VenueShowMap":false,"_VenueShowMapLink":false,"footnotes":""},"categories":[435],"tags":[],"class_list":["post-1325","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-aid-and-freindly-societies"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/posts\/1325","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/comments?post=1325"}],"version-history":[{"count":7,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/posts\/1325\/revisions"}],"predecessor-version":[{"id":35523,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/posts\/1325\/revisions\/35523"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/media\/1327"}],"wp:attachment":[{"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/media?parent=1325"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/categories?post=1325"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/tags?post=1325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}